| NPI | 1447655766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9325998) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN9325998) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9325998) | |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2026-07-19 |