NPI | 1538631387 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11028129) |
Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
Enumeration Date | 2018-12-18 |
Last Update Date | 2025-05-27 |