NPI | 1689209629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 1636155) |
Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: CO 1636155) |
Enumeration Date | 2020-03-10 |
Last Update Date | 2020-03-10 |