| NPI | 1629701032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 4026120) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1099382) |
| Enumeration Date | 2022-07-04 |
| Last Update Date | 2024-10-22 |