| NPI | 1669363057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71017041A) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71017041B) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IN 28276756A) | |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-11-09 |