| NPI | 1881720324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11006463) |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: MA 235546) |
| 364SP0812X Clinical Nurse Specialist, Psych/Mental Health, Community (Licence: MA 235546) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2021-04-06 |