| NPI | 1174063861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10015) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28181178A) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2019-06-11 |