| NPI | 1134870355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11017259) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11017259) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN325228) | |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2023-12-07 |