| NPI | 1114632841 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71014776A)  | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28176786A)  | 
| 163W00000X Registered Nurse (Licence: IN 28176786C)  | |
| 163W00000X Registered Nurse (Licence: OH RN.508444)  | |
| Enumeration Date | 2023-01-17 | 
| Last Update Date | 2023-12-21 |