| NPI | 1982831947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN R-175110-9) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R175110-9) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2021-01-19 |