| NPI | 1619681988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1026801) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G186334) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 7271272) | |
| 163W00000X Registered Nurse (Licence: TX 1026801) | |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2025-09-07 |