| NPI | 1043712862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP143192) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 854944) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH RN394717) | |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2025-12-04 |