| NPI | 1144984394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL 44371) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11016218) |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2026-04-14 |