| NPI | 1114135647 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MT 23169) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: MT 23169) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2017-11-02 |