| NPI | 1891179883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9250632) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9250632) |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: FL 9250632) | |
| 163WC0400X Registered Nurse, Case Management (Licence: FL 9250632) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL 9250632) | |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2019-08-15 |