| NPI | 1699825919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 213555) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9200934) |
| 363L00000X Nurse Practitioner (Licence: FL ARNP9200934) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 213555) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2012-12-12 |