NPI | 1346973187 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11020672) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11020672) |
Enumeration Date | 2022-07-08 |
Last Update Date | 2024-03-29 |