| NPI | 1508504986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704324662) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704324662) |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: MI 4704324662) | |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2026-02-16 |