| NPI | 1063728764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KS 53-75194-031) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-75194) |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2022-08-11 |