| NPI | 1063170256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71012882A) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IN 28151320A) |
| Enumeration Date | 2021-12-04 |
| Last Update Date | 2022-08-16 |