NPI | 1194738153 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 13918) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 162459) |
Enumeration Date | 2006-08-14 |
Last Update Date | 2019-02-21 |