| NPI | 1619181468 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/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 |