NPI | 1093249419 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 7588) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R-161518-0) |
Enumeration Date | 2017-04-12 |
Last Update Date | 2020-08-31 |