| NPI | 1285305177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 11061) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: MN 2234256) |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2023-11-27 |