| NPI | 1104538552 |
|---|---|
| Former Name | MATHEW V CHACKO |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1089361) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TX 739088) |
| Enumeration Date | 2022-12-16 |
| Last Update Date | 2022-12-16 |