NPI | 1669791430 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KY 3006444) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3006444) |
Enumeration Date | 2010-05-19 |
Last Update Date | 2011-05-09 |