| NPI | 1235741679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 14241564-4405) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 286456) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 14241564-4405) | |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2025-11-11 |