NPI | 1295478337 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1077935) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1077935) |
Enumeration Date | 2022-04-17 |
Last Update Date | 2024-12-06 |