| NPI | 1528181492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP133327) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 62751) |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2017-04-06 |