| NPI | 1225593726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704284763) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704284763) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2022-05-24 |