| NPI | 1164807178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71005703A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28181189A) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2024-02-07 |