| NPI | 1215413844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: FL APRN9458242) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9458242) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL RN9458242) | |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2024-04-26 |