| NPI | 1265180921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN284464) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: GA RN284464) |
| Enumeration Date | 2022-03-12 |
| Last Update Date | 2022-03-12 |