NPI | 1639055437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11041704.) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 2025040376.) |
Enumeration Date | 2025-08-15 |
Last Update Date | 2025-08-26 |