| NPI | 1861918757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1209357) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 925568) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2025-11-15 |