| NPI | 1083377568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1057298) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1057298) |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2023-10-02 |