| NPI | 1730063710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: MI 4704362739) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704362739) |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-12-15 |