| NPI | 1043689672 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 28165750A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71005761A) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2023-11-06 |