| NPI | 1336584812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11014846) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11014846) |
| 163W00000X Registered Nurse (Licence: OH RN.375949) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R182735) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2025-07-31 |