| NPI | 1699494153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71013243A) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.026233) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IN 28243197A) | |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2023-07-17 |