| NPI | 1003481052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11008974) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL APRN11008974) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11008974) | |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2026-10-14 |