| NPI | 1326566142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007557A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28195632A) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2018-06-16 |