| NPI | 1144726647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007903A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28202720A) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2018-10-23 |