| NPI | 1518179829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 34183) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 250126) |
| 225200000X Physical Therapy Assistant (Licence: TN 3390) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2023-07-07 |