| NPI | 1669815478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP133762) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN1560) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 66242) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP133762) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 66242) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2023-07-13 |