| NPI | 1437040466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11037292) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA GAA-NP003430) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95035135) | |
| Enumeration Date | 2025-07-09 |
| Last Update Date | 2025-07-09 |