| NPI | 1063679173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP1971252) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL ARNP1971252) |
| Enumeration Date | 2008-05-18 |
| Last Update Date | 2019-06-05 |