| NPI | 1790485621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KS 83479) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 150820) |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2024-12-06 |