| NPI | 1235771288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11015471) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: FL RN9512079) |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2021-10-27 |