| NPI | 1588440713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11029562) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: FL RN9556787) |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2023-11-10 |