| NPI | 1417483363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 28190643A) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 28190643A) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-09-14 |