| NPI | 1578529343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL ARNP9180117) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL ARNP9180117) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2023-11-14 |