| NPI | 1689831794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9358067) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH10986) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2023-05-15 |