| NPI | 1083036867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN500016132) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC14384) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2026-07-03 |