| NPI | 1154073963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71012102A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IN 2021185176) |
| Enumeration Date | 2022-01-23 |
| Last Update Date | 2022-09-22 |