NPI | 1417464736 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP136174) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP136174) |
Enumeration Date | 2018-01-08 |
Last Update Date | 2022-03-02 |