| NPI | 1265823330 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9483373) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health | 
| 363L00000X Nurse Practitioner (Licence: NC 5008341) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9483373) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 0000018806) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5008341) | |
| Enumeration Date | 2015-02-11 | 
| Last Update Date | 2025-06-09 |