| NPI | 1134629785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007855A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28198839A) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2018-03-23 |