| NPI | 1760074082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11013407) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2023-10-19 |