| NPI | 1912211764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 28484) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 171949) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 904213) | |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2023-08-01 |