NPI | 1588176069 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 5377813072) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 5377813072) |
Enumeration Date | 2017-10-24 |
Last Update Date | 2023-05-15 |