| NPI | 1891420121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11020944) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA GAA-NP000947) |
| 163W00000X Registered Nurse (Licence: FL RN9408112) | |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2024-08-19 |