| NPI | 1801381421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9356210) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9356210) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2024-03-12 |