NPI | 1821476094 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9302885) |
Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: FL APRN9302885) |
Enumeration Date | 2015-05-08 |
Last Update Date | 2025-06-26 |