| NPI | 1164433587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0001193977) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN RN00115147) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 7613) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2026-08-19 |