| NPI | 1912676669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71012926A) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IN 28220461A) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2023-01-24 |