| NPI | 1568079358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11040562) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 765455) |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2025-09-03 |