| NPI | 1184615999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71000896) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28147084A) |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2018-08-02 |