| NPI | 1134180243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY003277) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC APN 2602) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9206716) | |
| 103T00000X Psychologist (Licence: FL PY 6203) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071-005311) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN APN 0000011387) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA 196911NP) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2012-03-13 |