| NPI | 1770167850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11012847) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71011474A) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11012847) | |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2023-09-22 |