| NPI | 1063924108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11032161) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1032682) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61356809) | |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2024-07-16 |