| NPI | 1679603310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TN APN0000010677) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000143944) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2016-06-10 |