| NPI | 1285234096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71010523A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: IN 28221871A) |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2023-11-15 |