| NPI | 1316245558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP120017) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 796648) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP120017) | |
| Enumeration Date | 2011-03-12 |
| Last Update Date | 2022-11-04 |