| NPI | 1013535582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 28139746A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71010148A) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2021-02-09 |