| NPI | 1275936791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11008416) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN 9360188) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2020-11-03 |