| NPI | 1609409655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP145305) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 889919) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX 889919) | |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2022-10-05 |