| NPI | 1669095907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 28256) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9488515) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11008981) | |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2022-01-14 |