| NPI | 1205427549 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IA 078749) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041.242975) |
| Enumeration Date | 2021-01-29 |
| Last Update Date | 2021-01-29 |