| NPI | 1922738681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1083939) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: TX 840630) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2023-12-06 |