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 |