| NPI | 1659014504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71015032A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28223146A) |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2024-09-06 |