| NPI | 1063910933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 8560489-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8650489-3102) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 8560489-4405) | |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 8650489-4405) | |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2023-07-27 |