| NPI | 1194184242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9275493) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL APRN9275493) |
| 163W00000X Registered Nurse (Licence: FL 9275493) | |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2025-06-30 |