| NPI | 1609383082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3015473) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 23860) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000023860) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 23860) | |
| Enumeration Date | 2018-01-06 |
| Last Update Date | 2023-09-04 |