| NPI | 1164925715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: TN 220042) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: TN 220042) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TN 220042) | |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2024-08-02 |