| NPI | 1518413434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9302589) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9302589) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9302589) | |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2022-10-27 |