NPI | 1841657798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 45723) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 45723) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL TPAN1193) | |
Enumeration Date | 2016-01-23 |
Last Update Date | 2025-01-28 |