| NPI | 1801253083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 75598) |
| Additional Taxonomies | 364SP0813X Clinical Nurse Specialist, Psych/Mental Health, Geropsychiatric (Licence: TX 1114373) |
| 163W00000X Registered Nurse (Licence: TX 867533) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1114373) | |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2024-01-30 |