| NPI | 1669137725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11016361) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL APRN11016361) | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2023-09-27 |