| NPI | 1407367303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9338546) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9338546) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC APRN21345) | |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2021-12-06 |