| NPI | 1780851329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11028611) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: FL JA15885) |
| 163WE0003X Registered Nurse, Emergency (Licence: FL RN9439622) | |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2024-01-16 |