| NPI | 1609205533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704370738) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 18090) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2024-10-08 |