| NPI | 1861944993 |
|---|---|
| Professional Name | NONE NONE NONE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP132370) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2016-10-24 |