| NPI | 1336613611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN165385) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: AZ RN165385) |
| 163WP2201X Registered Nurse Ambulatory Care (Licence: AZ RN165385) | |
| 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: AZ RN165385) | |
| Enumeration Date | 2019-01-19 |
| Last Update Date | 2019-01-19 |