| NPI | 1225489529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1011818) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 58061) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2020-09-04 |