| NPI | 1265269369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 2154747) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MN 2154747) |
| Enumeration Date | 2024-09-14 |
| Last Update Date | 2024-09-14 |