| NPI | 1013369420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP141917) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5008712) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP141917) | |
| Enumeration Date | 2016-07-09 |
| Last Update Date | 2023-10-18 |