| NPI | 1427476811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71004912A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28196369A) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024189657) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2025-02-17 |