| NPI | 1881169555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11000303) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000303) |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2026-10-06 |