NPI | 1780097691 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3008684) |
Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KY 3008684) |
Enumeration Date | 2014-06-09 |
Last Update Date | 2025-05-21 |