NPI | 1164275665 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11042692) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9621918) |
Enumeration Date | 2024-04-08 |
Last Update Date | 2025-10-02 |