| NPI | 1114634821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL NP11022870) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL NP9380926) |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2022-11-04 |