| NPI | 1699253294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 21993) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71010511A) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 21993) | |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2025-07-02 |