| NPI | 1083902563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71003851A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28178865A) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2022-02-01 |