| NPI | 1205022555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71002603A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 8890) |
| 363L00000X Nurse Practitioner (Licence: ID 78183) | |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2024-01-11 |