| NPI | 1972987147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9333042) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL APRN9333042) |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2025-12-05 |