| NPI | 1952288714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 12513128-4405) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 12513128-4405) |
| Enumeration Date | 2025-08-21 |
| Last Update Date | 2025-11-19 |