| NPI | 1962235838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1169444) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1169444) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1169444) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 1169444) | |
| Enumeration Date | 2024-08-24 |
| Last Update Date | 2025-01-17 |