NPI | 1447448030 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 663143) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 663143) |
Enumeration Date | 2007-10-09 |
Last Update Date | 2024-07-16 |