| NPI | 1669702270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN3163082) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP3163082) | |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2022-02-24 |