| NPI | 1942750328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP138488) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 903979) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2019-02-08 |