| NPI | 1780855866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11002798) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11002798) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2023-06-02 |