| NPI | 1598142572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: NY 605293) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: NY 605293) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-04-29 |