NPI | 1235741679 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 14241564-4405) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 286456) |
Enumeration Date | 2020-08-18 |
Last Update Date | 2025-10-01 |