| NPI | 1770241572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL PMH06250045) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11016807) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2025-06-12 |