| NPI | 1073883815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 78511) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 78511) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95011142) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP130932) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP130932) | |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2024-05-27 |