| NPI | 1821444993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201404699RN) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2016-06-10 |