| NPI | 1861678708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN628023) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA PC005353) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2011-07-29 |