| NPI | 1598516148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: PR 97757) |
| Additional Taxonomies | 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: PR 97757) |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: PR 97757) | |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-04-01 |