| NPI | 1255985214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009287A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28191306A) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2021-05-13 |