| NPI | 1851692735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 263173-4405) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 263173-4405) | |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2024-03-18 |