| NPI | 1285216234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11012550) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9413104) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2022-06-03 |