| NPI | 1538609409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704275897) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704275897) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2023-10-11 |