| NPI | 1669952354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 24628) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 24628) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 4046751) | |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2025-09-23 |