| NPI | 1376150235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MN 7856) |
| Additional Taxonomies | 273R00000X Psychiatric Unit |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2020-11-23 |