| NPI | 1386005601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MN 4335) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN 306820) |
| 363LF0000X Nurse Practitioner Family (Licence: MN CNP 4335) | |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2024-09-05 |