| NPI | 1386109692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11001001) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL 11001001) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11001001) | |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2025-04-10 |