| NPI | 1316036213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01045336A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71005791A) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2021-03-23 |