| NPI | 1134462864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN APN0000017491) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TN RN0000177236) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2022-07-21 |