| NPI | 1235993478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71015044A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IN 28231543A) |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2024-05-09 |