| NPI | 1740860964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL APRN11015200) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: FL APRN11015200) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2024-08-13 |