| NPI | 1396209649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: FL APRN11001074) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11001074) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11001074) | |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2024-06-24 |