| 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 28176786C) |
| 163W00000X Registered Nurse (Licence: OH RN.508444) | |
| 163W00000X Registered Nurse (Licence: IN 28176786A) | |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2025-11-14 |