| NPI | 1083501571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11044449) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95036313) |
| 163W00000X Registered Nurse (Licence: CA 95115411) | |
| Enumeration Date | 2025-06-18 |
| Last Update Date | 2026-10-05 |