| NPI | 1417507203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1049231) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC RN1049231) |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2025-12-15 |