| NPI | 1104244664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: VA 0001235688) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: VA 0001235688) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: VA 0001235688) | |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: VA 0001235688) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2015-12-23 |