| NPI | 1619216744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 824845) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NM 824845) |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2014-03-04 |