NPI | 1235769498 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3014060) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3014060) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3014060) | |
Enumeration Date | 2020-01-16 |
Last Update Date | 2023-05-08 |