| NPI | 1861937773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: VA 0001238827) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001238827) |
| 163WC1500X Registered Nurse, Community Health (Licence: VA 0001238827) | |
| 163WH0200X Registered Nurse, Home Health (Licence: VA 0001238827) | |
| Enumeration Date | 2016-12-31 |
| Last Update Date | 2024-05-29 |