| NPI | 1982142691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 8654) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R-228642-4) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2022-01-21 |