| NPI | 1982945879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1111706) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 66644) |
| Enumeration Date | 2013-03-03 |
| Last Update Date | 2024-05-09 |