| NPI | 1417308313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 6293) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 7002) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MN 6293) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2024-06-10 |