| NPI | 1053962589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11004188) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11004188) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11004188) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11004188) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11004188) | |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2023-09-05 |