| NPI | 1902158546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 17055) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN 8566) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2015-07-24 |