| NPI | 1588847917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN APN16357) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN RN178745) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2011-12-21 |