| NPI | 1851908073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1015575) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 754290) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX 1015575) | |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2025-07-26 |