NPI | 1902550460 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11018353) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F022220136) |
363LF0000X Nurse Practitioner, Family (Licence: FL APRN11018353) | |
Enumeration Date | 2022-02-03 |
Last Update Date | 2025-10-08 |