NPI | 1891884649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 693051) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA 102750) |
363L00000X Nurse Practitioner (Licence: TX 693051) | |
363L00000X Nurse Practitioner (Licence: TX AP119552) | |
Enumeration Date | 2006-10-12 |
Last Update Date | 2024-12-10 |