| NPI | 1326448580 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 37376) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TN 266132) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2025-01-22 |