| NPI | 1669073029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 11078) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: MN 547) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2023-12-12 |