| NPI | 1528011426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TN APN7967) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TN 7967) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2012-08-15 |