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 |