| NPI | 1336878628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71012621A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71012621A) |
| 163W00000X Registered Nurse (Licence: IN 28251265A) | |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2026-02-23 |