| NPI | 1770164600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AR R086237) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: AR R086237) |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: AR R086237) | |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2021-04-21 |