| NPI | 1043975105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11025309) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: FL RN9544203) |
| 363L00000X Nurse Practitioner (Licence: FL F03230441) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 2023208786) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11025309) | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2024-07-24 |