| NPI | 1033491113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9233399) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 3791) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2017-02-23 |