| NPI | 1639693633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3011822) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: KY 1113948) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2023-11-27 |