NPI | 1861945743 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN CNP4747) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R190864-8) |
Enumeration Date | 2016-07-27 |
Last Update Date | 2020-10-29 |