| NPI | 1770814915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0600X Registered Nurse, Gerontology (Licence: NM R59159) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NM R59159) |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2010-01-28 |