| NPI | 1033758578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP144478) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0002957-C-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP144478) | |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2022-08-31 |