| NPI | 1114586328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71008938A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71008938A) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-06-11 |