| NPI | 1093534265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 80522) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-80522-071) |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2025-02-24 |