| NPI | 1194093807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71003875A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IN 28138800A) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2023-11-03 |