NPI | 1750689949 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041.173569) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.011523) |
Enumeration Date | 2011-03-11 |
Last Update Date | 2011-03-11 |