| NPI | 1588329619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1183602) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 899055) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2025-02-14 |