NPI | 1407108715 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 805136) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 805136) |
Enumeration Date | 2012-10-10 |
Last Update Date | 2023-09-07 |