| NPI | 1215350475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP126200) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 796494) |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2014-08-20 |