| NPI | 1962923375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11027912) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-21-53906) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2025-02-11 |