| NPI | 1972081248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 636869) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: NY 636869) |
| 163WC0400X Registered Nurse, Case Management (Licence: NY 636869) | |
| 163WS0200X Registered Nurse, School (Licence: NY 636869) | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2018-07-30 |