| NPI | 1942044037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11033066) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11033066) |
| 363L00000X Nurse Practitioner (Licence: FL APRN11033066) | |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2026-03-19 |