| NPI | 1194952374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9250280) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9250280) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2025-07-24 |