| NPI | 1518680214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 11135223-4405) |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: UT 11135223-8900) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2024-04-17 |