NPI | 1659640415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1113490) |
Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 308726-1) |
Enumeration Date | 2011-12-23 |
Last Update Date | 2023-10-25 |