NPI | 1962034892 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11006092) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL APRN11006092) |
363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006092) | |
Enumeration Date | 2020-02-08 |
Last Update Date | 2024-09-26 |