| NPI | 1912537267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1232892) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 973055) |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2026-07-16 |