| NPI | 1215414628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 0033633) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 24502) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11014425) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 24502) | |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2026-07-08 |