| NPI | 1871240721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1071648) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 882685) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 283320) | |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2025-07-16 |