NPI | 1972488781 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1207283) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 779887) |
Enumeration Date | 2025-08-11 |
Last Update Date | 2025-08-11 |