| NPI | 1780753681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 6371) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 706002) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 706002) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0000171) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-04-22 |