| NPI | 1104156280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV RN49768) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA 95021937) |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2015-09-03 |