| NPI | 1245860436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71010292A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28205128A) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71010292A) | |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2024-08-30 |