| NPI | 1184218695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11011653) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL 11011653) |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: FL 11011653) | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: FL 11011653) | |
| 363L00000X Nurse Practitioner (Licence: FL 11011653) | |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: FL 11011653) | |
| 364SP0812X Clinical Nurse Specialist, Psych/Mental Health, Community (Licence: FL 11011653) | |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2024-07-26 |