| NPI | 1699043315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: ID PA-950) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: ID PA-950) | |
| 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent (Licence: ID PA-950) | |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: ID PA-950) | |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2023-02-10 |