NPI | 1093854929 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11023448) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH7397) |
Enumeration Date | 2007-02-06 |
Last Update Date | 2023-01-20 |