| NPI | 1245037928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1232922) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AK 198483) |
| 163WA2000X Registered Nurse, Administrator (Licence: TX 865214) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-02-28 |
| Last Update Date | 2026-05-13 |