| NPI | 1831286731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: MN R178506-5) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TX 723743) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: TX 723743) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2012-06-14 |