| NPI | 1962235838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX 1169444) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 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 | 2025-05-22 |