| NPI | 1407466774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11007700) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL APRN11007700) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11007700) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11007700) | |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2023-12-13 |