NPI | 1316562499 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71010207A) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 28209048A) |
Enumeration Date | 2020-06-14 |
Last Update Date | 2020-10-02 |