| NPI | 1508239872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL ARNP9198046) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: FL ARNP9198046) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: FL ARNP9198046) | |
| Enumeration Date | 2015-11-08 |
| Last Update Date | 2022-09-30 |