| NPI | 1134628563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP136515) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-03539) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP136515) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM CNP-03539) | |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2021-09-15 |