| NPI | 1154408169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KS 74633) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: KS 13-41899-092) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-09-18 |