| NPI | 1457976615 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 28174509A) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71010247A) | 
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 28174509A) | |
| Enumeration Date | 2020-06-13 | 
| Last Update Date | 2025-07-31 |