| NPI | 1134983166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11031170) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL APRN11031170) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL APRN11031170) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11031170) | |
| Enumeration Date | 2024-02-09 |
| Last Update Date | 2024-07-24 |