| NPI | 1639331895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP116770) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 688758) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP116770) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2023-05-10 |