| NPI | 1013487552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MN 8623) |
| Additional Taxonomies | 163WH0200X Registered Nurse Home Health (Licence: MN 2251271) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2022-03-28 |