| NPI | 1194342063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX 1045065) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 808206) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2023-07-26 |