| NPI | 1629687124 |
|---|---|
| Professional Name | JUSTIN ROBERT WIRTH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 7559) |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2020-07-30 |