| NPI | 1245636471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9349258) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9349258) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2023-04-18 |