| NPI | 1477210789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0812X Clinical Nurse Specialist, Psych/Mental Health, Community (Licence: TX 104865) |
| Additional Taxonomies | 172A00000X Driver (Licence: TX 111013) |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2022-04-11 |