| NPI | 1972231181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704326887) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704326887) |
| 163W00000X Registered Nurse (Licence: WI 230027-30) | |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2022-10-27 |