| NPI | 1497427389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 814782) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TX 814782) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2023-01-24 |