| NPI | 1518735547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11032894) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11032894) |
| Enumeration Date | 2023-12-19 |
| Last Update Date | 2024-05-28 |