| NPI | 1184138364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9429559) |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: FL APRN9429559) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP140106) | |
| Enumeration Date | 2017-11-26 |
| Last Update Date | 2021-05-18 |