| NPI | 1801348321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 2018020811) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP132295) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2025-12-11 |