| NPI | 1285124628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 28217516A) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 28217516A) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2022-05-09 |