| NPI | 1427184308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9169554) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9169554) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9169554) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2023-03-07 |