| NPI | 1750913737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NM 58278) |
| Additional Taxonomies | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: NM 58278) |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2020-02-07 |