| NPI | 1821493297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT APRN-LIC-128574) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP126490) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2025-08-14 |