| NPI | 1558822403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 56993) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 204999) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP139601) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-09-25 |