| NPI | 1073409322 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71016960A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28275713A) |
| Enumeration Date | 2025-06-14 |
| Last Update Date | 2026-05-01 |