| NPI | 1568764934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA GA-NP003695) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP118998) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 221420) | |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2025-07-15 |