| NPI | 1093183600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009686) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3009686) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3009686) | |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2024-08-02 |