| NPI | 1295212611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71008446A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28191762A) |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2024-03-14 |