| NPI | 1992159230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL 9353605) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9353605) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2018-03-17 |