| NPI | 1487692455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP141532) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 1367-033) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9401608) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2021-12-03 |