| NPI | 1386750123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP114357) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 685411) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2023-07-19 |