| NPI | 1003477647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71009184A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28192553A) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2022-10-12 |