| NPI | 1225661002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: NV rn71078) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 20225) |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2021-01-05 |