| NPI | 1568875508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9348251) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9348251) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9348251) | |
| Enumeration Date | 2014-06-07 |
| Last Update Date | 2022-12-29 |