| NPI | 1083471593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 11758638-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 11758638-3102) |
| Enumeration Date | 2024-03-01 |
| Last Update Date | 2026-07-14 |