| NPI | 1881625150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 2485) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R1186606) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2022-04-29 |