| NPI | 1083276463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71009728A) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KY 3013592) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2020-01-31 |