| NPI | 1154075885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 8263832-4405) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 8263832-4405) |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2022-08-28 |