| NPI | 1790047926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9173113) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL APRN9173113) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL APRN9173113) | |
| 2084P0805X (Licence: FL APRN9173113) | |
| 261QH0100X Clinic/Center, Health Services (Licence: FL APRN9173113) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2022-04-18 |