| NPI | 1841517695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: LA 156751) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 4637) |
| 101YP2500X Counselor, Professional (Licence: TX 64787) | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2018-11-19 |