NPI | 1457994576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP142933) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024180323) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 091187-23) | |
Enumeration Date | 2019-10-21 |
Last Update Date | 2025-09-04 |