| NPI | 1982251070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11013622) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2021-06-11 |