| NPI | 1649940339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: MN 2482485) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: MN 2482485) |
| 163WE0003X Registered Nurse, Emergency (Licence: MN 2482485) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MN 2482485) | |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2026-04-30 |