| NPI | 1013359942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71004522A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209013764) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2023-05-18 |