| NPI | 1427521186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP139704) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP139704) |
| Enumeration Date | 2019-01-05 |
| Last Update Date | 2024-01-26 |