| NPI | 1487003422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11026530) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL TPPA183) |
| 363A00000X Physician Assistant (Licence: AZ 8885) | |
| 208D00000X General Practice (Licence: FL HSE35829) | |
| 363A00000X Physician Assistant (Licence: PR 373-PA) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2024-11-08 |