| NPI | 1912582008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11013174) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL F12200797) |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2025-02-21 |