| NPI | 1528514296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN61695) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC 61695) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2023-05-22 |