| NPI | 1962710277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 23508) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TN 333) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95019929) | |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2022-04-05 |