| NPI | 1881100121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9243092) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9243092) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9243092) | |
| Enumeration Date | 2017-12-22 |
| Last Update Date | 2021-09-11 |