| NPI | 1194919050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL APRN2987488) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 2987482) |
| 1744R1102X Specialist, Research Study | |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: FL APRN2987488) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 419395) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2024-10-03 |