| NPI | 1184719338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71006260A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001746A) |
| 225100000X Physical Therapist (Licence: IN 05010034A) | |
| 163W00000X Registered Nurse (Licence: IN 28195910A) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2016-06-13 |