| NPI | 1538432703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 10493) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 44680) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 10503499-4405) | |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2023-07-27 |