| NPI | 1194116822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WS0200X Registered Nurse, School (Licence: AZ 285526) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: OR 201242138RN) |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2023-01-19 |