| NPI | 1477105955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 319400) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 971587) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1110010) | |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2025-04-01 |