| NPI | 1063230555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1194362) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: TX 762541) |
| Enumeration Date | 2024-10-02 |
| Last Update Date | 2025-04-02 |