| NPI | 1538668298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9418311) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9418311) |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2022-02-15 |