| NPI | 1023873932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL APRN11031356) |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: FL APRN11031356) |
| Enumeration Date | 2024-02-20 |
| Last Update Date | 2024-02-28 |