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 | 363LF0000X Nurse Practitioner, Family (Licence: MO 2011034999) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2011034999) | |
Enumeration Date | 2010-07-20 |
Last Update Date | 2025-06-12 |