| NPI | 1598019119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL APRN9224109) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9224109) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2024-08-29 |