| NPI | 1689026924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL APRN9355850) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9355850) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: FL ARNP9355850) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2024-03-27 |