| NPI | 1720536691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL APRN11004343) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL MH8961) |
| 101YM0800X Counselor Mental Health (Licence: FL MH8961) | |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2024-05-01 |