| NPI | 1255339362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP108991) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP108991) |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: NH 090010-23) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2023-03-07 |