| NPI | 1427057652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN LSW4417) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 150387) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 11867) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2007-07-08 |