| NPI | 1659742443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP128982) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP128982) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2022-10-06 |