| NPI | 1194796987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007878A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 15880) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-10-02 |