| 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 Psychiatric/Mental Health (Licence: KY 3014060) | |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2023-05-08 |