| NPI | 1568814671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 27183) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 216030) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2021-04-28 |