| NPI | 1285940163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: MN 12329) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: MN R1927917) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2024-11-22 |