| NPI | 1235764580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: SC 222993) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 22293A) |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2020-03-06 |