| NPI | 1710467238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9393307) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2023-07-26 |