| NPI | 1356990915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009326A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 195749) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71009326A) | |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2023-08-02 |