| NPI | 1104156801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IN 71003214A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IN 71003214A) |
| 363LF0000X Nurse Practitioner Family (Licence: IN 28158256A) | |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2021-10-12 |