| NPI | 1164964805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP132486) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 803484) |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2021-06-10 |