| NPI | 1720040157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 529711) |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: TX RN LIC. NO. 529711) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2014-07-23 |