| NPI | 1548953458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704420286) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 846065) |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2024-11-26 |