| NPI | 1568263069 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 4036781) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1164510) |
| Enumeration Date | 2025-03-20 |
| Last Update Date | 2026-05-27 |