| NPI | 1003298423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: TX AP129633) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 783012) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2020-11-10 |