| NPI | 1366636854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 6135464-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 6135464-4405) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2025-06-10 |