| NPI | 1588964621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP134131) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TX 735371) |
| 163W00000X Registered Nurse (Licence: TX 735371) | |
| 163WG0000X Registered Nurse, General Practice (Licence: TX 735371) | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2023-10-16 |