| NPI | 1285117143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71008436A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28206231) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71008436A) | |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2026-07-21 |