| NPI | 1740708676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1032186) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 829535) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TX 1032186) | |
| 363L00000X Nurse Practitioner (Licence: CA 95008515) | |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2022-09-17 |