| NPI | 1285195339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71008988A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28216817A) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2023-03-07 |