| NPI | 1285310599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11027136) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0036044) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010530) | |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2024-11-05 |