| NPI | 1336697754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11015141) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 149745) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5009156) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015141) | |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2021-10-08 |