| NPI | 1912547019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11007522) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS100904) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11007522) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11007522) | |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2024-04-05 |