| NPI | 1942623830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MI 4704267891) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6802071586) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2014-01-28 |