| NPI | 1033133988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP112671) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 673045) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-08-29 |