| NPI | 1386677094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP120337) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 7921) |
| 363L00000X Nurse Practitioner (Licence: CO C-APN.0001544-C-NP) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 229867) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP120337) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 229867) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2022-05-19 |