| NPI | 1215535588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11008497) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11008497) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL 11008497) | |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2026-02-12 |