NPI | 1588430979 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1142455) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1142455) |
Enumeration Date | 2023-11-28 |
Last Update Date | 2024-01-08 |