| NPI | 1336824820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 684284) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL 9588368) |
| 101YP1600X Counselor, Pastoral | |
| 163W00000X Registered Nurse (Licence: FL 9588368) | |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2025-11-13 |