| NPI | 1992011555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: PR 412) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PR 9536) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2010-08-20 |