| NPI | 1639933567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OK 217068) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OK R0106739) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-83452-071) | |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-08-13 |