NPI | 1922796804 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 11636009-3102) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 11636009-3102) |
Enumeration Date | 2023-04-27 |
Last Update Date | 2025-06-16 |