| NPI | 1013480474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN F04180502) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28181822A) |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2020-09-15 |