| NPI | 1932505054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 76527) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-76527-011) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2024-02-09 |