NPI | 1023545076 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 56057) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP136365) |
Enumeration Date | 2017-05-20 |
Last Update Date | 2019-07-16 |