| NPI | 1144569203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: IN 71004358A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28147623A) |
| 363L00000X Nurse Practitioner (Licence: IN 71004358A) | |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2014-02-27 |