| NPI | 1104336387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9351187) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9351187) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2023-10-05 |