| NPI | 1508833401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 8321729-4405) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: UT 8321729-3102) |
| 247200000X | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2020-12-21 |