| NPI | 1992461206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3018429) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1136044) |
| Enumeration Date | 2021-11-10 |
| Last Update Date | 2024-04-01 |