| NPI | 1821491929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000017355) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN APN0000017355) |
| 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001773) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV APRN001773) | |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2022-08-19 |