| NPI | 1750575338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: SC 4291) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: SC R38298) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2011-09-15 |