| NPI | 1093401978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 90410) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 626394) |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2023-04-13 |