| NPI | 1003410697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0809X Clinical Nurse Specialist Psychiatric/Mental Health, Adult (Licence: MI 4704302358) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MI 4704302358) |
| Enumeration Date | 2020-11-24 |
| Last Update Date | 2023-01-17 |