| NPI | 1043090921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 10036424) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: IN 28231833A) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71015599A) | |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2025-01-02 |