NPI | 1619681988 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1026801) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G186334) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 7271272) | |
163W00000X Registered Nurse (Licence: TX 1026801) | |
Enumeration Date | 2023-01-10 |
Last Update Date | 2025-09-07 |