| NPI | 1982259784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11006947) |
| Additional Taxonomies | 2084P0805X (Licence: TX AP142483) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP142483) | |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2021-04-06 |