| NPI | 1629421664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP143703) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60669052) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TX 912786) | |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2023-09-08 |