| NPI | 1275080558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9241803) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: FL 9241803) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9241803) | |
| Enumeration Date | 2016-09-05 |
| Last Update Date | 2025-12-19 |