| NPI | 1508306788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024737) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2023-03-21 |