| NPI | 1902643919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1166903) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1166903) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX 1166903) | |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2025-04-25 |