| NPI | 1861485450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN3398622) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP3398622) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2023-05-31 |