| NPI | 1699384958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 191995-4) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 7558) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2024-08-26 |