| NPI | 1235386137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN2001992) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 2001992) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2025-07-07 |