| NPI | 1992655260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0400X Registered Nurse, Case Management (Licence: MI 4704392331) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MI 4704392331) |
| 163WP2201X Registered Nurse, Ambulatory Care (Licence: MI 4704392331) | |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: MI 4704392331) | |
| 163W00000X Registered Nurse (Licence: MI 4704392331) | |
| Enumeration Date | 2026-01-28 |
| Last Update Date | 2026-03-12 |