| NPI | 1639097918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 10001372) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2026-07-06 |
| Last Update Date | 2026-07-06 |