| NPI | 1700277464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV 874320) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 920278) |
| 163WN0800X Registered Nurse, Neuroscience (Licence: NV 874320) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NV 874320) | |
| 106S00000X Behavior Technician | |
| 163WG0000X Registered Nurse, General Practice (Licence: NV 874320) | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2024-05-29 |