| NPI | 1710257449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2012035127) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 136296) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2012035127) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-75839-072) | |
| 163W00000X Registered Nurse (Licence: KS 14-74250-072) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75839-072) | |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2026-07-02 |