| NPI | 1851004055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11023755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL APRN11023755) |
| Enumeration Date | 2023-01-03 |
| Last Update Date | 2025-08-07 |