| NPI | 1659080794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1112834) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 728599) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: SC 251249) | |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2023-06-07 |