| NPI | 1750105995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11036065) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9555670) |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2026-07-01 |