| NPI | 1013380591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71011878A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP129535) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2023-01-12 |