| NPI | 1639848419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11012428) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL APRN11012428) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11012428) | |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2024-04-29 |