| NPI | 1699537696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704366596) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0136887) |
| 363L00000X Nurse Practitioner (Licence: MI 4704366596) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 249028) | |
| Enumeration Date | 2024-01-25 |
| Last Update Date | 2024-05-13 |