| NPI | 1124601232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11025694) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 163W00000X Registered Nurse (Licence: FL RN9552371) | |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2023-04-13 |