| NPI | 1154863496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: HI 3888) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71008497a) |
| 363L00000X Nurse Practitioner (Licence: KY 3010790) | |
| 364SF0001X Clinical Nurse Specialist, Family Health (Licence: KY 3010790) | |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2022-12-09 |