| NPI | 1932823572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: UT 13050484-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 13050484-1206) |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2025-03-12 |