| NPI | 1316565104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL APRN11007437) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL 11007437) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2024-01-15 |