| NPI | 1194262485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9338031) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL APRN9338031) |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2024-11-12 |