| NPI | 1033309265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KS 53-77013) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-98315-032) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2022-08-18 |