| NPI | 1194670604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11045675) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH APRN11045675) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 4056124) | |
| Enumeration Date | 2026-03-02 |
| Last Update Date | 2026-06-09 |