| NPI | 1376092809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN2824142) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP2824142) |
| 363LF0000X Nurse Practitioner, Family (Licence: NH 090740-23) | |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2024-06-14 |