| NPI | 1942286901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP113929) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 664132) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 332221) | |
| 163W00000X Registered Nurse (Licence: NY 475853) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP113929) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 400612) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2021-09-19 |