| NPI | 1962399634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1037278) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP70030195) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G186018) | |
| Enumeration Date | 2025-06-23 |
| Last Update Date | 2025-09-06 |