| NPI | 1962787432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MD R175052) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R175052) |
| 163W00000X Registered Nurse (Licence: DC RN965924) | |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2024-11-18 |