| NPI | 1245687938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: LA 217715) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2021-07-12 |