| NPI | 1003263450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704247208) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704247208) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2018-11-19 |