| NPI | 1669076618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 12966) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: MN 2439886) |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2025-12-03 |