NPI | 1679503965 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA00642) |
Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX PA00642) |
Enumeration Date | 2006-07-03 |
Last Update Date | 2025-04-29 |