| NPI | 1972551398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 75195) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1118035) |
| 111N00000X Chiropractor (Licence: TX 8790) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2023-11-20 |