| NPI | 1942343256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: VA 0017140528) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: VA 0015000634) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: VA 0024169909) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2014-04-18 |