| NPI | 1083337836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11031661) |
| Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: FL RN9434481) |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2024-12-27 |