| NPI | 1801337894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11012508) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11012508) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R196106) | |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2024-08-21 |