| NPI | 1417471129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11014870) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-22-60150) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11014870) | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2024-05-15 |