| NPI | 1295086106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11008837) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11008837) | |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2025-03-28 |