| NPI | 1558626689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11029594) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL APRN11029594) |
| 363L00000X Nurse Practitioner (Licence: TX 783129) | |
| Enumeration Date | 2012-07-04 |
| Last Update Date | 2025-09-17 |