| NPI | 1174919377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9204952) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9204952) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9204952) | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2025-12-05 |