| NPI | 1407548829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL 11040634) |
| Additional Taxonomies | 363LS0200X Nurse Practitioner, School (Licence: FL 9410988) |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2025-09-11 |