| NPI | 1215371299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 0000017552) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TN RN0000185583) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 17552) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2024-03-01 |