| NPI | 1902445158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-79328-012) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-79328-012) |
| Enumeration Date | 2020-01-04 |
| Last Update Date | 2022-10-15 |