| NPI | 1952794687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 69489) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP127554) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 69489) | |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2023-12-28 |