| NPI | 1013802412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1213944) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95038650) |
| 163W00000X Registered Nurse (Licence: CA 95303179) | |
| 163WG0000X Registered Nurse, General Practice (Licence: TX 954568) | |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2026-03-18 |