| NPI | 1891295481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 23949) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TN 192570) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5016913) | |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2023-01-27 |