| NPI | 1336987973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1231631) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 898823) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2026-04-13 |