| NPI | 1245312180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9205122) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL 5846) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-06-04 |