| NPI | 1982268926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406944) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY NY767064) |
| 163W00000X Registered Nurse (Licence: NY 767064) | |
| 207Q00000X Family Medicine (Licence: FL HSE6403) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95034645) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11014614) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ 320419) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NY F348961-01) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ 320418) | |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2025-08-13 |