| NPI | 1134817935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 8262349-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 8262349-4405) |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2025-04-10 |