| NPI | 1235505850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 77011) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: KS 13-99252-052) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2015-10-15 |