| NPI | 1689121394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-82342-082) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0100475-C-NP) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0033216) | |
| Enumeration Date | 2016-09-10 |
| Last Update Date | 2025-09-19 |