| NPI | 1235676099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71007578A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28205187A) |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2021-03-31 |