| NPI | 1548576838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704401205) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 232406) |
| 372600000X Adult Companion | |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2024-10-18 |