| NPI | 1801203534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 66489) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP127354) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX ARNP9302212) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 66489) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 9302212) | |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2023-07-12 |