| NPI | 1932887338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11027323) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL APRN11027323) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: FL APRN11027323) | |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2024-05-07 |