| NPI | 1356524839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 19298) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 2447) |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2018-12-13 |