| NPI | 1427597335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PR 80463) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: PR 80463) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: PR 80463) | |
| 163WP2201X Registered Nurse, Ambulatory Care (Licence: PR 80463) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: PR 80463) | |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2021-05-24 |