| NPI | 1942556642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704255142) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704255142) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704255142) | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2024-08-26 |