| NPI | 1013742790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1194450) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA APRN-NP265824) |
| 163W00000X Registered Nurse (Licence: GA RN265824) | |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2025-10-30 |