| NPI | 1881453488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 11817116-4405) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: UT 11817116-4405) |
| Enumeration Date | 2024-03-15 |
| Last Update Date | 2024-04-12 |