NPI | 1356517445 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11033211) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 8918) |
Enumeration Date | 2008-05-08 |
Last Update Date | 2024-07-04 |