| NPI | 1649139189 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1192989) |
| Additional Taxonomies | 174N00000X Lactation Consultant, Non-RN |
| Enumeration Date | 2026-01-20 |
| Last Update Date | 2026-09-08 |