| NPI | 1487621843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN APN0000008322) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN0000008322) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN APN0000008322) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2016-11-30 |