| NPI | 1295775138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 74595) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: KS 14-78962-091) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2018-03-17 |