| NPI | 1972109684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1017007) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TX 903731) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0003311-C-NP) | |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2021-12-07 |