| NPI | 1215398532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP116347) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP116347) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2023-11-30 |