| NPI | 1881066991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NM RN-81941) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: NM RN-81941) |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NM RN-81941) | |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2015-10-28 |