| NPI | 1154737021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71005008A) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: IN 28177033A) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71005008A) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: IN 71005008A) | |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2018-03-21 |