| NPI | 1992355028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 6850) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2460930) |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2025-06-16 |