| NPI | 1770125098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL PA9112604) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9112604) |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: FL PA9112604) | |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2025-09-02 |