| NPI | 1013521905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71010360A) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IN 28209788A) |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2020-11-04 |