| NPI | 1366985046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71006936A) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IN 28196119A) |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2018-07-12 |