| NPI | 1598014201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TN 25032) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 225341) |
| 101YM0800X Counselor Mental Health (Licence: FL IMH8933) | |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2020-08-18 |