| NPI | 1013493972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9268132) |
| Additional Taxonomies | 104100000X Social Worker |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 9268132) | |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2024-04-11 |