| NPI | 1639574445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9227025) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL APRN9227025) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2025-11-05 |