| NPI | 1386166932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71014370A) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3011507) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3011507) | |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2026-03-02 |