| NPI | 1609103126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 23142) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000162518) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 23142) | |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2024-05-15 |