| NPI | 1518598010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TX 980416) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 980416) |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: TX 980416) | |
| 163WH0200X Registered Nurse, Home Health (Licence: CO 1667133) | |
| Enumeration Date | 2020-02-03 |
| Last Update Date | 2020-04-24 |