| NPI | 1184087629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71006220A) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71006220A) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2018-01-10 |