| NPI | 1285117143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 28206231) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 1133599) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2024-02-21 |