| NPI | 1457215196 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 13722) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95039158) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 225729) | |
| Enumeration Date | 2025-12-15 |
| Last Update Date | 2026-07-11 |