| NPI | 1275060287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9271041) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9271041) | |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2021-06-14 |