| NPI | 1518060870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 17148) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN LSW0000004761) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2012-11-11 |