| NPI | 1730528480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11029006) |
| Additional Taxonomies | 227800000X Respiratory Therapist, Certified (Licence: FL RT12124) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2023-10-10 |