| NPI | 1235161282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71000660A) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: IN 28107948A) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2011-08-24 |