NPI | 1003480203 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71011131A) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 80834) |
Enumeration Date | 2021-05-13 |
Last Update Date | 2022-10-20 |