| NPI | 1871126292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1026494) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1026494) |
| 163W00000X Registered Nurse (Licence: OH 465421) | |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2021-10-13 |