| NPI | 1861186421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-82284-012) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2023011241) |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2023-07-19 |