| NPI | 1407378128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: FL APRN9361022) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9361022) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 343196) | |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2023-06-19 |