| NPI | 1861503856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: TX 599005) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 022528-23-08) |
| 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent (Licence: TX 599005) | |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: TX 599005) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-12-18 |