| NPI | 1730571480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP127455) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 799103) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2021-07-28 |