| NPI | 1083449540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 10490668) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: TX 10490668) |
| Enumeration Date | 2024-09-04 |
| Last Update Date | 2024-09-04 |