NPI | 1710579669 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11010875) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11010875) |
Enumeration Date | 2021-02-10 |
Last Update Date | 2023-09-29 |