| NPI | 1427486265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: RN2286853) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2286853) |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2013-10-14 |