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 |