| NPI | 1760296701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1000674) |
| Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: TX 1000674) |
| Enumeration Date | 2025-02-01 |
| Last Update Date | 2025-10-02 |