| NPI | 1700276060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MN R 89695-5) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3455-125) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2015-01-26 |