| NPI | 1841877024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1034285) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 863633) |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2022-06-22 |