| NPI | 1134368327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX RN796897) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN 330129) |
| 163W00000X Registered Nurse (Licence: TX 796897) | |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2016-11-08 |