| NPI | 1801814637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: MD R066653) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: PA RN343136L) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-01-05 |