| NPI | 1710386289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-159176) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TX 809089) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP126135) | |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2019-01-17 |