| NPI | 1609567957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71014117A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R220189-4) |
| 163W00000X Registered Nurse (Licence: IN 28235293A) | |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2023-08-02 |