NPI | 1972110765 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11008957) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11008957) |
Enumeration Date | 2020-09-26 |
Last Update Date | 2025-05-08 |