NPI | 1518356278 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP127220) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP127220) |
163W00000X Registered Nurse (Licence: TX 759937) | |
Enumeration Date | 2015-01-20 |
Last Update Date | 2021-03-09 |