| NPI | 1750005120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5019594) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 871023) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1096162) | |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2024-05-17 |