| NPI | 1063043164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11005915) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11005915) |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2022-02-28 |