| NPI | 1770527285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: IN 71000256A) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: IN 28113375A) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2007-11-07 |