| NPI | 1548396344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP2729582) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: FL ARNP 2729582) |
| 363L00000X Nurse Practitioner (Licence: FL ARNP2729582) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2013-08-13 |