| NPI | 1245897701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN-11021754) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-19-83572) |
| 163W00000X Registered Nurse (Licence: FL RN-9364398) | |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2022-11-07 |