| NPI | 1669160057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1123431) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 59735) |
| 163W00000X Registered Nurse (Licence: TX 1123431) | |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2025-08-11 |