| NPI | 1407108715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX 805136) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 805136) |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2023-09-07 |