| NPI | 1851860548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-24-74918) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11000084) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000084) | |
| Enumeration Date | 2018-11-25 |
| Last Update Date | 2024-09-17 |