| NPI | 1982007431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3008775) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3008775) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2021-11-03 |