| NPI | 1205454857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 28222582A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71010160A) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2020-08-31 |