| NPI | 1962210690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 1968086) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: MN 1968086) |
| Enumeration Date | 2024-12-27 |
| Last Update Date | 2025-08-28 |