| NPI | 1134880958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1259529) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 828393) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 273608) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G167616) | |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2023-09-27 |