NPI | 1851692735 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 263173-4405) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
363LF0000X Nurse Practitioner, Family (Licence: UT 263173-4405) | |
Enumeration Date | 2010-11-09 |
Last Update Date | 2024-03-18 |