| NPI | 1386492882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 4021140) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1162592) |
| Enumeration Date | 2024-05-09 |
| Last Update Date | 2024-06-24 |