| NPI | 1770863805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP120594) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61071398) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP120594) | |
| Enumeration Date | 2011-08-20 |
| Last Update Date | 2026-05-21 |