| NPI | 1962299891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11038583) |
| Additional Taxonomies | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: FL APRN11038583) |
| 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: FL APRN11038583) | |
| Enumeration Date | 2025-04-23 |
| Last Update Date | 2025-08-15 |