| NPI | 1942811088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 28231030A) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: IN 71010409A) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: IN 28231030A) | |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2024-02-18 |