| NPI | 1629511290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9231258) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9231258) | |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2024-01-25 |