| NPI | 1760846786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TRN39743) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 9361098) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN39743) | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2024-08-16 |