| NPI | 1922256759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: MN 2008005899) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R- 176318-4) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2008-09-04 |