| NPI | 1982450318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11030438) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: FL 9481771) |
| 163W00000X Registered Nurse (Licence: FL 9481771) | |
| 363L00000X Nurse Practitioner (Licence: FL 11030438) | |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: FL 9481771) | |
| Enumeration Date | 2024-04-26 |
| Last Update Date | 2026-07-20 |