| NPI | 1225623465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1126797) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 971139) |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2023-08-01 |