| NPI | 1962034892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL APRN11006092) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL APRN11006092) |
| 101YM0800X Counselor Mental Health (Licence: FL APRN11006092) | |
| Enumeration Date | 2020-02-08 |
| Last Update Date | 2025-07-02 |