| NPI | 1831034925 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1132375) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1132375) |
| Enumeration Date | 2026-04-23 |
| Last Update Date | 2026-05-27 |