| NPI | 1689233058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11002687) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002687) |
| 363L00000X Nurse Practitioner (Licence: FL APRN11002687) | |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2023-12-07 |