| NPI | 1285274530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11005657) |
| Additional Taxonomies | 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: FL APRN11005657) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202006086NP-PP) | |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2023-12-19 |