| NPI | 1336183276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704269668) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704269668) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2024-12-11 |