| NPI | 1003289885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP130997) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R186924) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP130997) | |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2025-01-09 |