| NPI | 1215406657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0812X Clinical Nurse Specialist, Psych/Mental Health, Community (Licence: FL 11000701) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11000701) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL RN9340756) | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2021-12-21 |