| NPI | 1407628514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-82871-031) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-148962-031) |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2024-03-25 |