| NPI | 1194213025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX ap135901) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX ap135901) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 2021013683) | |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-12-15 |