| NPI | 1073826962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-81458-061) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2011034999) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 364403-4405) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2011034999) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2025-01-11 |