| NPI | 1558356428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 3333912) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP3333912) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2023-07-19 |