| NPI | 1760710164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704280816) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801069202) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MI 4704280816) | |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2021-09-02 |