| NPI | 1043026008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11036668) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11036668) |
| 163W00000X Registered Nurse (Licence: FL RN9532123) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11036668) | |
| Enumeration Date | 2024-12-05 |
| Last Update Date | 2026-03-29 |