| NPI | 1013689785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71012243A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28191965A) |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2022-05-23 |