| NPI | 1649983198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 8695221-8900) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8695221-3102) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 8695221-4405) | |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2023-11-28 |