| NPI | 1528390788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9229025) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: FL ARNP9229025) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL ARNP 9229025) | |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2018-05-04 |