| NPI | 1982251724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 2022059050) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: MI 4704343729) |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2023-02-07 |