| NPI | 1346259900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN APN0000005254) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000038532) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2019-07-29 |