| NPI | 1558837609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11002545) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: FL PMD533870) |
| 163WE0003X Registered Nurse, Emergency (Licence: FL RN9293932) | |
| 251B00000X Case Management (Licence: FL CBHCMS100925) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002545) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP142336) | |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2023-02-22 |