| NPI | 1770835985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1100871) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 311050) |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2023-09-12 |