| NPI | 1851050850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX 1059875) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL 11016970) |
| Enumeration Date | 2021-12-17 |
| Last Update Date | 2025-04-15 |