| NPI | 1184907289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP111791) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM CNP00980) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN0002938-C-NP) | |
| Enumeration Date | 2011-09-25 |
| Last Update Date | 2015-06-26 |