| NPI | 1770883993 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN R-168743-5) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 3160) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2022-02-21 |