| NPI | 1962073999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11014075) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11014075) | |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2024-12-12 |