| NPI | 1033858154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11019409) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9526162) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11019409) | |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2026-08-27 |