| NPI | 1801378500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1225237) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: TX 868607) |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2026-03-16 |