NPI | 1861154353 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11015924) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL 11015924) |
Enumeration Date | 2021-10-12 |
Last Update Date | 2025-04-10 |