| NPI | 1245769355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007643A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28155898A) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2021-02-01 |