| NPI | 1790659605 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704374814) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704374814) |
| 163W00000X Registered Nurse (Licence: MI 4704374814) | |
| Enumeration Date | 2025-10-02 |
| Last Update Date | 2025-10-02 |