| NPI | 1922454651 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: TX 1012663) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health | 
| 363L00000X Nurse Practitioner (Licence: TX 1012663) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1012663) | |
| 364S00000X Clinical Nurse Specialist (Licence: TX 1012663) | |
| Enumeration Date | 2016-05-12 | 
| Last Update Date | 2025-08-20 |