| NPI | 1154174118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11043349) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 913738) |
| Enumeration Date | 2024-04-09 |
| Last Update Date | 2026-01-23 |