NPI | 1700223492 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 2023063403) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
251B00000X Case Management | |
363LF0000X Nurse Practitioner, Family (Licence: FL APRN11004591) | |
Enumeration Date | 2013-06-04 |
Last Update Date | 2024-04-12 |