| NPI | 1649674797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95006452) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 763720) |
| 163W00000X Registered Nurse (Licence: CA 95119878) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP126629) | |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2023-04-14 |