| NPI | 1518356278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP127220) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP127220) |
| 163W00000X Registered Nurse (Licence: TX 759937) | |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2021-03-09 |