| NPI | 1942767637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11000982) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL APRN11000982) |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2023-05-22 |