| NPI | 1992166383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 4333) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN 4333) |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2026-05-05 |