| NPI | 1396247359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN286020) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9326452) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9326452) | |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN286020) | |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2024-11-05 |