NPI | 1194342063 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1045065) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 808206) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-06-26 |
Last Update Date | 2023-07-26 |