| NPI | 1235720327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KS 53-79867-121) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KS 53-79867-121) |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2025-04-23 |