| NPI | 1649673187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9364840) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL APRN9364840) |
| 364SF0001X Clinical Nurse Specialist, Family Health (Licence: FL F0914579) | |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2025-02-25 |