| NPI | 1811419641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: MN 2404015) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: MN 2404015) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2021-11-02 |