| NPI | 1518364363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9237460) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL CBHCMS0100408) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2023-02-08 |