| NPI | 1932701794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ RN190404) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: AZ RN190404) |
| 163W00000X Registered Nurse (Licence: AZ RN190404) | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2022-02-08 |