| NPI | 1154600963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9480216) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 048991-23) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9480216) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN275639) | |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2025-10-16 |