| NPI | 1184371338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 14184137-4405) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: UT 11647011-3102) |
| Enumeration Date | 2022-03-08 |
| Last Update Date | 2025-12-08 |