| NPI | 1376250548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NC 313410) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 174H00000X Health Educator | |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2022-10-27 |