| NPI | 1619862877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NM 54744) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: NM 54744) |
| Enumeration Date | 2025-06-10 |
| Last Update Date | 2025-06-10 |