| 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 |