| NPI | 1073197794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11012992) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ NJDCATEMP041658) |
| 207Q00000X Family Medicine (Licence: FL HSE24274) | |
| 207Q00000X Family Medicine (Licence: IN CV2102936) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11012992) | |
| Enumeration Date | 2021-05-09 |
| Last Update Date | 2021-12-09 |