| NPI | 1043370687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000007383) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024169795) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 7383) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2017-03-15 |