| NPI | 1033585609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 5376922052) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015025674) |
| 363LF0000X Nurse Practitioner, Family (Licence: KS 5376922052) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2019047655) | |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2023-08-03 |