| NPI | 1992327738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 71968) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 146643) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 5379777022) | |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2023-02-10 |