| NPI | 1083176713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: KY 1155177) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1155177) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2024-08-15 |