| NPI | 1730697715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9484520) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9484520) |
| 363LF0000X Nurse Practitioner, Family (Licence: DC RN10457546) | |
| Enumeration Date | 2018-01-12 |
| Last Update Date | 2023-05-10 |