| NPI | 1194171694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AK NURR36892) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: AK NURR36892) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2024-04-28 |