| NPI | 1649756354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 10899873-4405) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP138067) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 33381) | |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2023-09-14 |