| NPI | 1861867228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9381223) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 403332) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: FL ARNP9381223) | |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: FL ARNP9381223) | |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2023-01-16 |