| NPI | 1871123976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1019588) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TX 922068) |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2024-09-05 |