| NPI | 1447978846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 317178) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171400000X Health & Wellness Coach | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2022-08-22 |