| NPI | 1053030015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11022656) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9398628) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 309763) | |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2025-06-04 |