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 |