| NPI | 1740405711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP145177) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP145177) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 864711) | |
| 225700000X Massage Therapist | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2024-02-08 |