| NPI | 1073910428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0993529) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 864323) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP127135) | |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2022-07-19 |