| NPI | 1376032011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11023493) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2026-07-13 |