| NPI | 1710669890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1119542) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 1119542) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2025-03-03 |