| NPI | 1174298764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71012584A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28220091A) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 2021085859) | |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2025-11-11 |