| NPI | 1407260565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9382656) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9382656) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN CNP3773) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2024-03-07 |