| NPI | 1326412552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3009891) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3009891) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3009891) | |
| Enumeration Date | 2015-11-27 |
| Last Update Date | 2024-02-23 |