| NPI | 1689353815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1039373) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2023-07-26 |