NPI | 1912763137 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX 1039115) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1039115) |
Enumeration Date | 2024-02-26 |
Last Update Date | 2024-04-05 |