| NPI | 1184050544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP124414) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 758330) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP124414) | |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2024-09-06 |