Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1053215 | TX |
NPI | 1003119116 |
---|---|
Provider Name | Mr. Walter Akwo |
First Address | San Jose, CA 95128-4311 |
Second Address | Fate, TX 75087-0227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2010 |
Last Update Date | 27/12/2021 |