| NPI | 1629556295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP138498) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 226388) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 824486) | |
| Enumeration Date | 2018-08-05 |
| Last Update Date | 2019-08-14 |