| NPI | 1699416883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11019026) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9532396) |
| 208D00000X General Practice (Licence: FL 9532396) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2023-06-07 |