| NPI | 1669959359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 28180366A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71008320A) |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2025-09-29 |