| NPI | 1629629803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP143252) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP1435252) |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2024-03-25 |