| NPI | 1093151227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: NV RN72654) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 7877248-3102) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2013-05-15 |