| NPI | 1427533868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9351933) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9351933) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2026-05-12 |