| NPI | 1780308635 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: DC RN1052050) | 
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: VA 0001287123) | 
| Enumeration Date | 2022-10-03 | 
| Last Update Date | 2022-10-03 |