| NPI | 1659122539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11032059) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11032059) |
| Enumeration Date | 2024-03-29 |
| Last Update Date | 2026-05-12 |