| NPI | 1265675789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9347480) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH9567) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2016-03-09 |