| NPI | 1013398155 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704237213NSA2504F) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704237213) | 
| Enumeration Date | 2015-06-15 | 
| Last Update Date | 2025-06-10 |