| NPI | 1730879545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM CNP74900) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OK 215093) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1118807) | |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2026-07-30 |