| NPI | 1215126826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MO 2018012807) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OK 401) |
| 225200000X Physical Therapy Assistant (Licence: MO 2001024018) | |
| 363LF0000X Nurse Practitioner Family (Licence: KS 53-75922-092) | |
| 163WM0705X Registered Nurse Medical-Surgical (Licence: MO 2004031658) | |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2020-04-08 |