| NPI | 1619181468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX AP111107) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 626669) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TX 626669) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2025-08-27 |