NPI | 1841877024 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1034285) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 863633) |
Enumeration Date | 2021-03-25 |
Last Update Date | 2022-06-22 |