| 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 |