| NPI | 1326305194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN924895) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9248953) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2024-09-27 |