NPI | 1649756354 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 10899873-4405) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP138067) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 33381) | |
Enumeration Date | 2018-07-16 |
Last Update Date | 2023-09-14 |